ORTHOSES

Presented by Reena Prem

Moderated by
Mrs. Sidhiprada M.
 OUTLINE

 Introduction
 Biomechanical principles- forces and principles of orthoses
design
 Examination procedures for Orthoses applications
 Designing and Prescribing Orthoses
 Orthoses for Lower Limb
 Orthoses for Upper limb
 INTRODUCTION
 “Orthotics” –term emerged in the late 1940s

 Orthosis – a device applied externally to the body to replace a missing function for improving
stabilization and dynamic control.

 Nicolas Andry - a body’s misshape did not have to be permanent, devices can be developed to
correct a misshapen spine or limb

 The American Board for Certification in Orthotics and Prosthetics was formed in 1948 to establish
and promote high professional standards.
 ORTHOTICS AND ORTHOSIS
 Orthotics is the unit of Rehabilitation that deals with improving the
function of the body by the application of a device that aids a body
part and helps to replace a missing function.
 An orthosis is a device manufactured
 Nomenclature of Orthosis
Braces, calipers, and corsets were used
Now a standard terminology system has been developed that
uses the name of each joint it crosses in the correct sequence with the
letter ‘O’ attached at the end
 BIOMECHANICS
 Planes- Sagittal, frontal, transverse
 Displacement- translation(linear),
rotation(angular displacement), curvilinear
motion(both)
 External forces- Gravity and Ground reach
force, Line of Gravity- CoM, GRFV(line CoM
and CoP)
 Internal Forces-muscles, joint capsules, and
ligaments
 Forces- distraction, compression, shear,
torsion, and bending
 Counterforce system-
 BIOMECHANICAL PRINCIPLES
Methods of Force application to produce
movement
1. Material and components that store and
release energy: rubber, thermoplastics,
carbon fiber, and titanium
2. Design and Trimlines
3. Functional Electrical stimulation
Methods of Force Application to Limit, Control,
or Prevent Movement
1) Counterforce system
2) Appliance rigidity
3) Mechanical joint- single or polyaxial
Biomechanical factors that affect the Appliance-
User interface
4) Reduce the magnitude of the force by
increasing the length of lever arm.
5) Reduce the pressure-relief depressions,
increase the total contact area
6) Alignment of mechanical and anatomical
joint
 EXAMINATION PROCEDURES

Examine the patient

Interview, Medical records Physical exam, Functional

Evaluate findings
Impairment, functional limitation, needs Participation restriction, goals

Identify functional goals and Hypothesize all methods to improve function

Orthosis Other interventions

 DESIGNING AN ORTHOSIS
TYPES OF ORTHOSIS
 METALS AND FABRIC
 Metals- stainless steel( strong, heavy), aluminum( light, less
strong), titanium( strong, lightweight, cost is high)
 Fabric- synthetic fabric-neoprene (flexible and resilient)
Cotton webbing- straps and belts
 Plastics- monomers-ethylene, polymers-propylene
Polymerize to form longs chains- polyethylene/propylene
THERMOPLASTICS:- materials are solid in room temperature and malleable
when heated

Low temperature(150 degrees) High temperature( 300 degrees)

 Molded directly on the patient  Molded on positive model of
 Less strong patient
 Used for UL orthosis  More strong
 Used in LL or Spine orthosis
Foamed Thermoplastics Elastomers Thermoplastics
 Formed by forcing nitrogen or  Resilient
other gases into the plastic during  Viscoelastic-
heating  Ability to absorb and dissipate
 Will mold and conform to the shape loads
of the body part  Used in shock-absorbing shoe
 Used in foot orthosis inserts
 SHOES
THE UPPER THE SOLE MODIFICATIONS
 Shoe depth  Outsole  Internal- insole or shoe insert
 Toe box height and width  Midsole Cushioning and shock absorption,
 Height of quarters  Insole and relieving pressure-sensitive
 Throat style  Heel structures
 Type of closure  Shank  External - outsole or heel
 Counters Balance limb length, relieve
pressure-sensitive areas on the
plantar surface of the foot, and
shift CoP
LOWER LIMB ORTHTICS
 FOOT ORTHOSES
ACCOMMODATIVE FUNCTIONAL

• Designed to provide protection and relief
• Types-1) soft and molded 2) soft and non-
molded
• Uses- to reduce plantar pressure, improve
shock absorption, reduce shearing forces and
relieve painful or pressure-sensitive structures
• Materials – Plastazole(foamed thermoplastic)
durometer – medium
• Designed to control and support subtalar, rearfoot,
and forefoot in biomechanical functioning.
• Types- 1) Semirigid 2) Rigid
• Uses- to affect the function and minimize
unwanted compensatory motions
• Materials- Plastazote, durometer- firm
 PEDIATRIC FOOT ORTHOSES
Denis Browne splint Bebax bootie(hinged)

Dynamic foot abduction orthosis

 ANKLE ORTHOSES

Lace-up AO- restricts motion of the

(medial and lateral)Stirrup-type AO- restricts
calcaneus and subtalar joint( flexion and
inversion and eversion
extension)
 ANKLE- FOOT ORTHOSES
Classified by the type of Materials
1) Conventional
2) Molded
3) Hybrid/ hinged
4) Functional Electrical stimulation
CONVENTIONAL AFO’s
 Shoe- strong counters to stabilize calcaneus
 Medial and lateral uprights
 Mechanical joint aligned with anatomical joint
 Ankle stops- restrict motion in predetermined
ROM
 T- STRAP to control varus(inversion) and
valgus( eversion)
force.
MOLDED AFO

Full/ hemi spiral

Posterior leaf spring
Posterior calf shell- rigid orthoses
orthoses - flexible
Acts as spring
ANTERIOR FLOOR REACTION AFOs
 To control both the ankle and knee
 Prevents knee buckling during stance phase by restricting ankle motion (quads weakness)
 Orthoses hold the ankle in neutral with dorsiflexion
stops
HYBRID AFOs FUNCTIONAL ELECTRICAL AFOs

Stimulation to common peroneal nerve

Calf component and foot plate near fibular head
 KNEE ORTHOSES

Conventional KAFO:-
Metal uprights, thigh and calf bands in
leather , attached shoes

Carbon fiber composite plastics:-

Strong and lightweight
KNEE LOCKS

Posterior offset joint-

drop ring
Provides knee extension
in stance phase Cam lock- upward
Adjustable dial lock
Moves GRFV anteriorly bail release
ANTERIOR FLOOR REACTION AFOs
Same as AFOs

Extends the knee in

stance but allows knee
flexion in swing phase

Knee lock with

mechanical or
electrical remote
controller
Electrical sensors- tilt
sensors

Electrical stance control

Supracondylar- GR-AFO
Orthosis
KNEE ORTHOSES
Types
1) Elastic fiber/ neoprene- synthetic rubber
2) Rigid- double uprights, lightweight metal or composite plastic materials

Postsurgical/ rehabilitative
orthoses- only safe joint ROM
with dial locks

Functional knee orthoses- three-

point counterforce system -
hyperextension
Patellofemoral orthoses- patellar pain Knee orthoses for valgus deformity- using
due to lateral tracking three- point force system
 HIP ORTHOSES
 HIP CONTROL USING ORTHOTIC HIP JOINTS
Louisiana state university reciprocating gait
orthosis
Isocentric reciprocating gait
Walkabout gait orthosis
orthosis
ORTHOSES FOR THE PARAPLEGIC

Standing frame Rochester Parapodium Swivel walker

PARASTEP- Functional
electrical stimulation
Postoperative Hip orthoses
HIP CONTROL USING GRFV

Scott-Craig- KAFO provides

stance phase hip extension-
GRFV is pushed posterior to
hip joint
HIP ORTHOSIS WITH SELECTED HIP CONDITIONS

Rhino cruiser Pavlik Harness

Atlanta orthoses
UPPER LIMB ORTHOTICS
The orthoses can be called Splints, brace, or orthoses

Splint Classification System(SCS)

1) Articular/ Non-articular- articular(wrist splint), non-articular(humeral splint)
2) Location:- depending upon the anatomy
3) Direction:- describes the direction of force applied or the joint position
supported
4) Purpose:- Immobilize a joint/ structure, mobilize tissue or assist movement,
restrict a joint motion
Categories of UL orthoses
1) Static splints:- supports the joint of a body part in a predetermined position of
rest or functional position. Serial static or Static progressive
2) Dynamic splint:- provides low load prolonged stress to increase tissue length or
substitute missing function (end range force is dynamic unlike static progressive
splint)

Static splint of elbow with

Dynamic splint for radial nerve injury
turnbuckle
 SHOULDER ORTHOSES

Function:- support/ immobilize after surgery, stabilize joint dislocation/ fracture.

Sling type immobilizers

Shoulder abduction
Wilmer carrying orthoses Gunslinger orthoses
positioning sling
 ELBOW ORTHOSES
Function:- restrict motion to protect healing structures and mobilize contractures limiting ROM

ARTICULATED NON- ARTICUALTED

 ROM stops can allow  Moulded from low temperature

Free motion between Thermoplastics
them  Immobilises the elbow joint
 Can be changed
according to patients
progress
 FOREARM ORTHOSES
Function:- to restore supination and pronation, primary injury to the forearm of secondary
immobilization to elbow or wrist

Forearm neutral rotation Compression band for

Dynamic forearm splint tennis elbow
immobilization orthoses
 WRIST AND HAND ORTHOSES
Function:- to improve or prevent impairments
 Splints for reduced ROM:- static progressive and dynamic splints, apply sustained low
mobilizing loads

Static progressive splint to Dynamic digit spring extension

increase IP joint extension splint
Splints for Impaired Hand function Splints for Joint Instability

Dynamic splint for lost muscle function for

radial nerve injury
Ulnar drift restriction splint
THANK YOU